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Eosinophilic granuloma of the pediatric cervical spine
Luca Denaro1, Umile Giuseppe Longo, Rocco Papalia
1Department of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
Insights
Pediatric eosinophilic granuloma of the cervical spine is rare and challenging to manage. Surgery is essential for cases with neurologic involvement, while other treatments aim for stability and pain relief in growing children.
Area of Science:
- Pediatric Orthopedics
- Pediatric Oncology
- Spine Surgery
Background:
- Eosinophilic granuloma (EG) of the pediatric cervical spine is a rare condition requiring tailored management due to the absence of high-level evidence.
- Treatment goals include maintaining spinal stability, preserving neurologic function, and alleviating pain in growing children.
- Cervical spine involvement is exceptionally uncommon, with fewer than 50 cases reported historically.
Observation:
- A retrospective review of 7 pediatric patients diagnosed with eosinophilic granuloma of the cervical spine between 1970 and 1990.
- All patients had isolated cervical spine involvement with a confirmed histologic diagnosis of EG and open physes.
- Patient demographics included 5 boys and 2 girls, with a mean age of 10 years (range 4-16), followed for a mean of 19 years.
Findings:
- Clinical presentation varied based on tumor location within the cervical spine.
- Management strategies included observation, immobilization, chemotherapy, surgical curettage, corticosteroid injection, and radiation therapy.
- Surgical intervention was necessary for patients presenting with neurologic deficits.
Implications:
- Effective management of pediatric cervical spine EG, particularly with neurologic compromise, remains challenging.
- Vertebral interbody fusion in pediatric patients can lead to a normal cervical spine shape and preserved adjacent segment motion long-term.
- Individualized treatment approaches are crucial for optimizing outcomes in this rare pediatric condition.
Study Design:
Retrospective case review of children with eosinophilic granuloma of the cervical spine.
Objective:
To present the clinical features, radiographic findings, management, and results of 7 pediatric patients with eosinophilic granuloma of the cervical spine.
Summary Of Background Data:
Management of the eosinophilic granuloma of the pediatric cervical spine is challenging, and must be adapted according to the patient, as no level I evidences have been produced. The therapeutic goals in these children are spinal stability, preservation of neurologic function, and relief of pain, always keeping in mind that patients are still growing. The localization in the cervical spine of children is extremely rare, with less than 50 patients reported in literature between 1966 and 2008.
Methods:
We reviewed the 7 pediatric patients with a diagnosis of eosinophilic granuloma of the cervical spine who were managed between 1970 and 1990 by the senior author. All patients presented with isolated cervical spine involvement, and all of them had a histologic diagnosis of eosinophilic granuloma (EG). All had open physes.
Results:
There were 5 boys and 2 girls (mean age: 10 years; range 4-16). We followed-up patients for 19 years (range 8-29). The symptoms at presentation varied according to the localization of the tumor in the cervical spine.
Conclusion:
Management of pediatric patients with EG of the cervical spine is challenging, especially when there is neurologic involvement. Observation alone, prolonged immobilization, systemic chemotherapy, curettage with or without bone grafting, corticosteroid injection, and low dose radiation therapy have been proposed for the management of patients with EG. Surgery is required when the child presents neurologic involvement. Children who received a vertebral interbody fusion can show, at long period follow-up, normal shape of the neck, with maintenance of the normal motion of the adjacent segments.